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POLSKI

PRZEGLĄD CHIRURGICZNY 10.2478/v10035-011-0058-9
2011, 83, 7, 367–371

Ileus and intestinal obstruction – comparison between
children and adults

Mehran Peyvasteh1, Shahnam Askarpour1, Hazhir Javaherizadeh2,
Somaieh Taghizadeh1
Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahwaz, Iran1
Arvand International Division , Ahvaz Jundishapur University of Medical Sciences2

Bowel obstruction is the interference with movement of bowel content. Large and small in testing from
duodenum to anal region can be obstructed mechanical or non-mechanical and complete or partial.
Mechanical obstruction can presented because of obstructive causes in intestinal lumen, intestinal
wall or pressure from other tissue on intestine.
The aim of the study was to evaluate etiology, laboratory findings of intestinal obstruction and ileus
among children and adults who discharged with good condition.
Material and methods. This retrospective study was carried out from 2001 to 2006 in Imam Khomei-
ni Hospital (Ahvaz-Iran). Cases of bowel obstruction were included in this study. For each case, a
questionnaire was filled. There are 752 cases with suspected bowel obstruction. From 752 cases, 403
patients that agreed and treated and discharged with good condition were studied. Cases were di-
vided into two groups: children (age < 15 yrs) and adults (age> 15 yrs). Data were analyzed by SPSS
Ver 16.0 (Chicago, IL, USA) and Epi-info Ver 6.00.
Results. In our study, 221 adults and 192 children were included. Mortality rate was 12.2%. Forty-
eight percent of 403 cases were children (m – 61%, f – 38%, ambigus genitalia – 1%) and 52% were
adults (m – 67%, f – 33%). Etiology of bowel obstruction in children were as follows: ileus (26%); adhe-
sion band (17.7%), partial obstruction (16.1%), and Hirschsprung’s disease (12%). Causes of bowel
obstruction in adults are: partial obstruction (29.9%); ileus (19%); adhesion band (18.5%); colonic
pseudo obstruction(8.5%); GI cancer (5.2%); hernia (4.7%); Crohn (2.8%); fecal impaction (3.3%); be-
zoar (2.4%), and 4.7% for other causes. Fifty-one percent of children and 36% of adults were operated.
Of all children, 91.7% had upright abdominal X-ray, 51.6% had supine X-ray, and 80.7% had sonogra-
phy. Hundred percents of adults had upright & supine plain abdominal X-ray and 75.4% had sonog-
raphy. Most change in children’s CBC was 10000<WBC<15000 and in adult for WBC<10000.
Conclusions. Partial obstruction, pseudo-obstruction, and cancer were more common in adults than
children. Ileus was the commonest cause of obstruction in children and it was partial obstruction for
adult. Children were more operated than adult. Sonography was more use for children but plain ab-
dominal X-ray for adult. In 45% of children 10000<WBC<15000 while most adult had WBC<10000.
Hypokalemia was the most common biochemical finding in both group.
Key words: bowel obstruction, ileus, adhesion band, Hirschsprung, intussusceptions, fecal impaction,
colonic pseudo obstruction, diverticulitis, hernia, imperforate anus

Intestinal bowel obstruction is a common neoplasm (4). Large intestinal obstruction
surgical emergency and commonly cause a (LBO) is most often the result of colo-rectal
problem in abdominal surgery (1, 2). The lead- malignancies. One large study found an inci-
ing cause of SBO in developed countries is post dence of 16% (5). Patients are often over 70
operative adhesions (60%) followed by malig- years old. The risk of obstruction increases the
nancy, Crohn disease, gallstone (3), and her- further down the bowel the lesion is sited, as
nias, although some studies have reported the contents become more solid. Tumors are
Crohn disease as a greater etiologic factor than often advanced with 25% having distant me-

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05 Imperforate anus 2 (1. Of tal a tertiary referral hospital.6 Intussuception 13 (6.05 Post radiation 0 3 (1. and other factors. and 1 (0. Table 1. From patients underwent surgery.73%) p=0. The etiology were recorded for patients.35%) were >15 yr. 192 tion and ileus among children and adults who (47. 142 (67.04%) 0) nie dotyczy / NA Cancer 0 11 (5. As seen in tab. From all patients. (52. There is no cases that treated and discharged with good difference between children and adults for condition were studied.53%) p=0. From 192 children pa- tients.USA) and Epi- differences between etiology of bowel obstruc. tion in different countries because of different nutritional habits.08%) 3 (1.42%) p=0. Hirschsprung’s for treatment. Iran. 1. There are possible by SPSS Ver 16. after 15 years old.2 Gastric outlet obstruction 1 (0. From 211 This retrospective study was carried out adult patients.0 (Chigaco. Sev- questionnaire was filled for each case.95%) p=0. Ahvaz. The remaining 403 children than adults (p<0.45%) p=0. 2).12%) 6 (2. tastases.08 Adhesion band 34 (17.14 Fecal impaction 6 (3.21%) p=0.42%) p=0. info ver 6. Ninety.85%) p=0.001 Pseudo-obstruction 6 (3.52%) 6 (2. male and 69 (32.84%) p=0.2 Crohn disease 0 6 (2. LBO is and adults.004 Tuberculosis 0 3 (1.01%) patients from 211 adult study.42%) p=0. Laboratory findings identification and intervention.70%) 39 (18. diverticulitis. 261 (64.29%) patients were between 2001-2006 in Imam Khomeini Hospi.two cases were died and disease and atresia were more common in excluded from this study. laboratory findings of intestinal obstruc. From all of and cancer were significantly more seen in 752 cases. patients and 98 (51.368 M. Four hundred and three patients were ogy. A questionnaire an emergency condition that requires early filled for each patient.0.77%) 0) p=0.97%) patients were male. IL.76%) were males.14%) 63 (29.42%) p=0.00 Diverticule 5 (2. Data were analyzed of LBO is age dependent (7). Peyvasteh et al.52%) 3 (1.05).64%) patients were <15 yr and 211 discharged with good condition.04%) 40 (18. pseudo-obstruction. before 15 years old the tumor or in a dilated caecum (6). intus- ruled out and transferred to other department susceptions.5%) patient had ambigus genitalia.05). Etiology of intestinal obstruction in children and adults Dzieci / Children Dorośli / Adults p / p-value (n=192) (n=211) Ileus 50 (26. 72 Material and methods (37.04%) from 192 of children struction were admitted to hospital.12%) 18 (8.05 Malrotation 4 (2.68%) 0) p=0. A all 403 cases. ticipate in our study and excluded. 228 cases did not agree to par.02 Volvulus 4 (2. Ileus. In this enty-six (36. Patients were divided durartion of hospital staying (tab.84%) p=0.89 Bezoar 1 (0.08%) 0) p=0.08%) 10 (4.00 Atresia 9 (4.84 Partial obstruction with unknown etiology 31 (16. included in our study. 752 cases with diagnosis of bowel ob.60%) 0) p=0.84%) p=0.5%) patients were female. Results As one of the most important condition surgical emergency we aimed to study of etiol. in 29 cases bowel obstruction was adults than children (p<0. 119 (61.86 Hirschsprung 22 (11. partial obstruction. these cases.48%) p=0. weather.001 Unauthenticated Download Date | 3/7/16 3:35 PM .16 Hernia 4 (2.7%) patients were female. Perforation can occur at the site of into two groups: children.

05) of bowel obstruction (10).64%).31%). sions. There is no significant difference between partial obstruction (16. 3).8%) adults than children (p=0.42%) Hyponatremia 23 (11. Marko- in adults.92%) and Hirschsprung’s disease CBC changes p-value (13.16%) p=0.97%) 13 (6. and barium enema ogy of children intestinal obstruction in our (tab.54%) (49.27%) 37 (17. study.65 Male constitute 74% and female 26% of >15 days 11 (5. upper GI series. reported adhesions (64.33 (10.48%).9 (16. Major causes of intestinal obstruction were intus- Table 3.72%) 19 (9%) p=0.20%) 4 (1. Of 192 children cases and 211 <5 days 32 (16.001 Table 4. endoscopy. obstructed inguinoscrotal Children Adults hernia (16. 4). 261(64. anorectal malforma- obstruction tions (22.95%) were the most adults while polycythemia was more common common causes of bowel obstruction.04%). study and similar to our study (8).81%) 31 p=0. 12.18%) p=0.17%) Azotemia 10 (5.03* (34.44%) (75.44%) 8 (3.76%) p-value (n=192) (n=211) were males. Adhe- children (p=0.85%). and large bowel chemical findings were significantly common cancer constitutes the most frequent causes in adult cases compared to children (p<0.53%) p=0.001 Hypernatremia 3 (1.69%) Children Adults Procedure p-value (n=192) (n=211) Abdominal X-ray 176 211 <0.89%) p=0.06 Barium enema 20 22 0.22 tive hernias as the most common cause (8.33%) 111 (52.04). (45. reviewed etiology of intestinal obstruction in 130 cases.64%) 15 (5.23%).16%) 4 (1.61%) (100%) Abdominal X-ray 99 211 <0. Frequency of hospital staying in patients with Discussion intestinal obstruction Children Adults In our study.11%) Polycythemia 15 (7.001 Hyperkalemia 8 (4.45%) were the most common etiol- phy. This difference (tab.89%) (25.89%) p=0.79%) 0.03) (tab. and abdominal may be due to partial obstruction in our X-ray (supine and upright) were more fre. Azotemia and normal bio. CBC changes in patients with intestinal susceptions (29. have found (38.0006* (82. and ileus (18. incarcerated hernias..65%) (100%) p-value (n=192) (n=211) Upper gi series 14 (7. Ogundoin et al. In adult cases. WBC<10000 was more common in giannakis et al.97%) cases and 142 5-10 days 112 (58. WBC >15 000 31 24 p=0.60%) p=0.37%) Anemia 67 53 p=0. adhesion band Anemia was more common in children than (18.85%) (11).04* Colonoscopy 0 35 <0. of all 403 cases.05). prung (11.04%) 89 (42.16 (16.21 intestinal obstruction in Malik et al.03* Table 5. 5). study.68%) p=0. 10-15 days 37 (19. and Hirschs­ children and adults regarding use of sonogra.06 Endoscopy 0 21 <0.56%) 2 (0. between the current study and other studies Colonoscopy.31%) (39.58%) Hypokalemia 71 (36.66%) 44 (20.089 Normal 94 (26. 119 (61.85%) p=0.63%) (10.33%) 13). Biochemical findings in the bowel obstruction (supine) (93.97%) 97 (45.70%). (n=192) (n=211) WBC <10 000 74 104 p=0. were the most common causes of intestinal Hyponatremia was most frequently seen in obstruction among adult cases (9).990 Hyperglycemia 7 (3. Ileus and intestinal obstruction – comparison between children and adults 369 Table 2. Ileus (26.16%) p=0.97%) p=0.18 (11.. quently used in adults than children (p<0.001* Sonography 155 159 0.001 Children Adults (upright) (52. partial obstruction (29. Radiologic procedures performed in patients (14.20%) 32 (15.94%) p=0.03* A number of recent studies. adhesion bands (17.28 adult cases.122 Hypoglycemia 10 (5.24 (67.14%) (11.28%) adhesive obstruction to be replacing obstruc- WBC 10 000–15 000 87 83 p=0.29%) cases were males respectively.35%) Unauthenticated Download Date | 3/7/16 3:35 PM .

7% respectively (22). hernia was reported as the 3rd common 12. ileus. and female reproductive system agement. In 45% of children current study. and partial obstruction were treated by non surgi- the mortality rates in conservative therapy cal management. procedure (21). In Jeong et al.2% (23). and non surgical treatment (30). the current surgical treatment. tinal obstruction in children was intussucep. Sonography was used Crohn disease accounting for 3-7% of small more commonly in children’s but plain ab- bowel obstruction in some studies (24). 2-3% of obstruction was due to intussuception Volvulus was found in 2. Higher rate of diagnosis (17). showed that there is male/female et al. In the current study. Madziga mortality rate was 13. doscopy and colonoscopy in adults than chil- toneal injury.84% 10000<WBC<15000 while most adult had of cases. The most prevalent single to be reasonable. In Kaiser thology or secondary to malrotation of the in- et al. Crohn was indentified in 2. operated than adult.6% of the patients underwent tion (15). malrotation in unusuall findings tion were seen in adults. are the most frequent causes of intestinal ob- Obstruction due to bezoar was seen in 2. sion.370 M. Most of patients were ad- of adult cases and half of them were more than mitted between 5-10 days. study. and partial obstruction are the most common causes of intestinal obstruction in Conclusions children. In the Croome’s study. easy use of diagnostic procedure such as en- however. testine (26.8%. Kőssi Dakubo et al. There were 57. patients and surgical intervention groups were 1.1999 to 31.2%. paralytic ileus. intestinal obstruction due to hernia was male. Children were more 50 years old.3% had previous history of primary cancer and and 1. of children and 36. Kryzan showed that intestinal obstruction due Partial obstruction.12. In Teon et al.08%) of children and no adult cases. Wyoski and tion are the most common causes in children. accounting for ap.01% of adults underwent tion in adults and 7th in children. 51. adhe. the rate of intus.42% of adults. malrotation was found in 4 biochemistry results. malrotation develop during the 1st year children and adults. In the current study no cases of intussucep. upper obstruction were treated by conservative man- abdominal.1. adhesion band. the surgical treatment. Unauthenticated Download Date | 3/7/16 3:35 PM . In another study carried out in Poland. Intra ab. of life (25). after childhood period. study..04% Hernia is the 6th cause of intestinal obstruc. obstruction due to Ileus. this may be the result of difference in surgical In the current study. WBC<10000. proximately 65% to 75% of cases (19. most are acquired as a result of peri. Hypokalemia was the (2. cause of intestinal obstruction (16). So. but these patients and Nuhu also reported hernia as the most had intestinal obstruction due to large intes- common causes of intestinal obstruction tine malignancy (28). Volvulus can be primary pa- susceptions in children was 6.77%. in up most common biochemistry finding among to 90%.2% of adult patients. study 80% of patients with The overall mortality rate was 1. Most of the patients has normal In our study. dominal adhesions are the most common cause In the current study all of the patients with of SBO in some reports.08% of children and (14). In the dominal X-ray for adult. 27). initial operation causing adhesion induced In our study. The number of the obstruction from 1. study. the most common cause of intes.1999 on 123 patients with hernia in our study was too low hospitalizations.6%. and partial obstruc- cancer is 5. and adhesion band to cancer has 17. 1. In the study which carried out by Moon Overall mortality rate in our study was et al. the most common cause of which dren.4% struction in adults. 20). The higher rate of malignancy in adults. of intestinal obstruction may be due to more Adhesions may be acquired or congenital. In the current study. may be another cause. studied post operative adhesion induced ratio was about 8/1 (29). In our study. 100% of patients with partial intestinal obstructions were colorectal. is abdominal pelvic surgery (18). Peyvasteh et al.

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